Invoice Ophthalmologist in Afghanistan Kabul –Free Word Template Download with AI
Specialized Ophthalmology Clinic
Address: 123 Shahr-e-Naw Street, Near Central Bank
Kabul, Afghanistan
Tel: +93 (0) 20 123 4567
Email: [email protected]
Tax ID: AF-TAX-99887766
Invoice #: INV-2023-10-045
Date: October 24, 2023
Due Date: November 07, 2023
Payment Terms: Net 14 Days
Bill To:
Patient Name: Ahmadullah Karzai
Address: House #45, Street #12, Karte-e-Se, Kabul, Afghanistan
Phone: +93 (0) 70 123 4567
Insurance Provider: Kabul National Health Insurance (If applicable)
Policy Number: KNHI-88776655
| # | Description of Ophthalmological Services | Quantity | Unit Price (AFN) | Total (AFN) |
|---|---|---|---|---|
| 1 |
Comprehensive Eye Examination Includes visual acuity testing, refraction, and slit-lamp examination performed by a certified Ophthalmologist in Kabul. |
1 | 1,500.00 | 1,500.00 |
| 2 |
Dilated Fundus Examination Detailed inspection of the retina, optic nerve, and macula using mydriatic drops. Essential for detecting diabetic retinopathy and glaucoma. |
1 | 2,000.00 | 2,000.00 |
| 3 |
Optical Coherence Tomography (OCT) Advanced imaging scan of the retina layers to assess macular degeneration and other retinal pathologies. |
1 | 3,500.00 | 3,500.00 |
| 4 |
Prescription Eyeglasses (Single Vision) High-quality lenses and durable frame selected for daily wear. Includes anti-reflective coating. |
1 | 4,500.00 | 4,500.00 |
| 5 |
Consultation Fee - Senior Ophthalmologist Professional fee for diagnosis and treatment planning by Dr. Farid Ahmadi, MD, FACS. |
1 | 2,500.00 | 2,500.00 |
| 6 |
Medication: Artificial Tears (Preservative-Free) Lubricating eye drops prescribed for dry eye syndrome management. |
2 | 350.00 | 700.00 |
| 7 |
Medication: Antibiotic Eye Ointment Topical antibiotic prescribed for minor conjunctival irritation. |
1 | 250.00 | 250.00 |
Terms and Conditions & Payment Instructions
This Invoice is issued by Kabul Vision Care Center, a leading Ophthalmology practice in Afghanistan Kabul. All services listed above were rendered by qualified medical professionals specializing in eye care. The total amount is due within 14 days of the invoice date. Late payments may incur a 2% monthly interest charge.
Payment Methods Accepted:
- Cash (Afghan Afghani - AFN) at our Kabul clinic reception.
- Bank Transfer to Kabul Bank, Account Name: Kabul Vision Care Center, Account No: 1234567890.
- Mobile Banking (M-Paisa or My T-Cash) to +93 70 123 4567.
Please reference Invoice Number INV-2023-10-045 with all payments. For insurance claims, please submit this original Invoice along with your medical report to your provider. Our clinic adheres to the medical standards set by the Ministry of Public Health of Afghanistan. If you have any questions regarding this Invoice or the ophthalmological services provided, please contact our billing department at +93 (0) 20 123 4567.
Thank you for trusting Kabul Vision Care Center with your eye health. We are committed to providing high-quality ophthalmological care to the community of Kabul and beyond.
Authorized Signature
Dr. Farid Ahmadi, MD
Chief Ophthalmologist
Patient Acknowledgment
Signature: _________________________
Date: _________________________
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